Arthrofibrosis of the knee is a complication of injury or surgery where an excessive scar tissue response leads to painful restriction of knee motion, with early adhesions and later scar tissue forming within the joint and soft tissue spaces, and persisting despite routine rehabilitation exercises and stretches.
|Side view of section through a normal knee, where there are no adhesions locking up movement.||Adhesions developing in the suprapatellar pouch, posterior capsule and anterior interval may create flexion loss, extension loss or both.||Matured scar tissue has contracted, closing the important spaces that normally allow movement, and pulling the kneecap right down.|
Rehabilitation issues with arthrofibrosis
Range of motion problems in early arthrofibrosis can be reversed with empathetic management - progressing patellar mobilisation and range of motion exercises in combination with adequate pain relief without pushing the joint into painful inflammation that makes things worse. Manipulation under anaesthesia may help to break adhesions before they become permanent scar tissue. Advanced arthrofibrosis may need surgical lysis of adhesions to regain range of motion, in combination with specialist pain management and physiotherapy.
Arthrofibrosis and patella baja (patella infera)
As the soft tissues behind and below the kneecap (patella) become involved in the scar tissue process, the kneecap may be pulled into an abnormally low position (patella baja) which may result in considerable pain with walking.
Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee.. Millett PJ, Williams RJ 3rd, Wickiewicz TL. Am J Sports Med. 1999 Sep-Oct;27(5):552-61.
The role of capsular distention in the arthroscopic management of arthrofibrosis of the knee: A technical consideration. Millett PJ, Steadman JR. Arthroscopy. 2001 Sep;17(7):E31.
Treatment of Knee Arthrofibrosis and Quadriceps Insufficiency after Patellar Tendon Repair: A Case Report Including Use of the Graston Technique. Black D. Int J Ther Massage Bodywork. 2010; 3(2): 14–21.
- Range of motion
- Anterior Interval arthrofibrosis
- Manipulation under anaesthesia
- Lysis of adhesions
Kindle eBook - Authors: Frank Noyes & Sue Barber-Westin
Knee Arthrofibrosis: Everything You Need to Know to Recognize, Treat, and Prevent Loss of Knee Motion After Injury or Surgery